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Christine Lovly, MD, PhD ON ROUNDS
Tennessee Facing Litigation Over Medicaid Practices Delays in TennCare Determinations at Heart of Lawsuit Tennessee became one of the first states in the nation to face litigation over its Medicaid practices in the post-reform era when three advocacy groups filed suit on behalf of clients they say have waited far beyond the legal limit for a determination of TennCare eligibility ... 2
TennCare Responds to Criticism, Lawsuit & Looks to the Future Between a much-publicized letter of reprimand from the Centers for Medicare & Medicaid Services in June and a lawsuit filed in July, the Bureau of TennCare has been on the receiving end of criticism from a number of parties across the state and further afield ... 4
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Cancer Drug Studied at SCRI Shows Big Promise By MELANIE KILGORE-HILL
A novel therapy first used at Sarah Cannon Research Institute (SCRI) is changing the prognosis for relapsed blood cancer patients. In late July, the U.S. Food and Drug Administration approved Zydelig® (idelalisib) for patients with relapsed chronic lymphocytic leukemia (CLL), relapsed follicular B-cell non-Hodgkin lymphoma and relapsed small lymphocytic lymphoma. While the drug is new to pharmacies, patients and physicians at Sarah Cannon have used idelalisib since participating in its phase 1 clinical trial more than six years ago. Tennessee Oncology’s Ian Flinn, MD, PhD, leads the hematologic malignancies research program at SCRI and said idelalisib was a breakthrough and effective therapy from the onset. “Sarah Cannon was the first to treat patients with idelalisib, and we started seeing immediate activity which is pretty unusual,” Flinn said. “This early activity generated a lot of enthusiasm, and it started causing groundswell. People in the field said it was different than what we’ve seen before, and it got to be known very quickly within the field.” (CONTINUED ON PAGE 8)
A robust clinical trials program at SCRI brings cutting-edge medicine to their patients and helps advance the knowledge base to impact the broader population.
Kraft Healthcare Leads Cuban Trade Mission Local Execs Study National Health System By CINDy SANDERS
Cuba had been on Scott Mertie’s bucket list for years. When he finally had a chance to visit this past January as part of a person-to-person cultural exchange, the president of Kraft Healthcare Consulting, LLC soon recognized it should be on the bucket list of other healthcare executives, as well. What started as a personal desire to tour the country rapidly turned into professional interest. As a communist society, the healthcare system is 100 percent government run. “Their quality of healthcare is considered very good,” Mertie noted. “Their life expectancy is among the longest in the Americas.” Although quick to add he isn’t advocating for socialized medicine in the United States, Mertie said it is intriguing to see how Cuba has set up their healthcare delivery system in (CONTINUED ON PAGE 12)
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Tennessee Facing Litigation Over Medicaid Practices
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Delays in TennCare Determinations at Heart of Lawsuit By CINDY SANDERS
Tennessee became one of the first states in the nation to face litigation over its Medicaid practices in the post-reform era when three advocacy groups filed suit on behalf of clients they say have waited far beyond the legal limit for a determination of TennCare eligibility. The Southern Poverty Law Center, Tennessee Justice Center and National Health Law Program filed suit on July 23 in the U.S. District Court for the Middle District of Tennessee. Darin Gordon, Larry B. Martin, and Raquel Hatter, PhD, in their respective official capacities as director of the Bureau of TennCare, commissioner of the Tennessee Department of Finance and Administration and commissioner of the Tennessee Department of Human Services have been named as defendants. In a conference call with statewide media representatives, lawyers for the plaintiffs alleged the state was playing politics by adopting policies that have deprived vulnerable citizens of healthcare coverage for which they are eligible and kept others, who might or might not ultimately be eligible, hanging in limbo with no determina-
tion date in sight. The attorneys said the Centers for Medicare and Medicaid Services have long required eligibility decisions be made within 45 days of an individual filing an application. However two of the plaintiffs, each facing a health crisis, had already waited more than 140 days without receiving any determination. “No one wants to be here today,” said Michele Johnson, co-founder and executive director of the Tennessee Justice Center (TJC). “The state of Tennessee has failed its citizens. The results have been unimaginable and unacceptable.” Sam Brooke, a seMichelle nior staff attorney at the Johnson Southern Poverty Law Center, stated, “We have filed a federal lawsuit today, Wilson v. Gordon, because Tennessee is frankly playing politics with the lives of their citizens.” He added that Tennessee has made it more difficult than any other state in the nation to enroll in its Medicaid program. “They’re throwing a monkey wrench into their own Medicaid program so the can
demonize the federal government. People in dire need of medical care are being sacrificed,” Brooke said. He noted the 45-day requirement for determining eligibility isn’t a new rule, nor is the requirement that calls for a hearing if a denial or no determination is made. “What is new is Tennessee’s decision to ignore both these requirements,” he asserted. The attorneys said failure to render a decision or to offer a channel to settle a dispute violates an applicant’s right to due process. The group added they have been meeting with TennCare officials for several months to address a variety of issues, several of which were outlined in a sternly worded mitigation letter from CMS to TennCare in late June accusing the state of failing to meet six of seven critical success factors required by federal healthcare law. “To their credit,” said Brooke, “they have addressed some of the other issues but have drawn a line in the sand on this.” Johnson said the backlog stems from a decision to end in-person assistance for residents trying to apply for TennCare. Tapping into federal funds, Tennessee has invested $35 million in an upgraded computer system that will hopefully alleviate
An important hearing regarding this case was scheduled for Aug. 29, which fell after our print deadline for the September issue. Please go online to NashvilleMedicalNews.com for updates regarding the lawsuit.
the situation. However, Johnson said 100 people in county offices who served as inperson resources for applicants were laid off before seeing if the computer system functioned properly … it didn’t. Now, TennCare officials seem unable to offer a timeline as to when the system will be operational. Instead all applications for TennCare are being funneled through the federal marketplace website, healthcare.gov, which Johnson said was neither set up for nor intended to process and determine eligibility for TennCare’s 27 unique categories. Jane Perkins, legal director for the National Health Law Program, noted, “It is clear Tennessee is a national outlier. We are monitoring enrollment in other states, and at this point, Tennessee is among the worst … if not the worst … offenders.” She added, “This is the first case that has been filed to challenge a state’s failure to process applications in a timely manner.” The phones have continued to ring at the TJC as individuals share stories of their battles with red tape and radio silence from anyone who could make a determination on
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TennCare Responds to Criticism, Lawsuit & Looks to the Future By CINDY SANDERS
Between a much-publicized letter of reprimand from the Centers for Medicare & Medicaid Services in June and a lawsuit filed in July, the Bureau of TennCare has been on the receiving end of criticism from a number of parties across the state and further afield. Asked to respond to questions about how the state handles applications for enrollment and to comment on the current lawsuit, Bureau of TennCare Spokesperson Sarah Tanksley shared insights into the processes in place in Tennessee. It should be noted that she asserts applicants can receive in-person assistance with the application process at any county Department of Human Services office. Plaintiffs in the pending lawsuit allege such assistance is nonexistent other than to point to a computer or phone. As for the pending lawsuit, Tanksley offered the following statement: “TennCare takes very seriously our role in assuring our citizens have access to the healthcare coverage available under the Affordable Care Act, and we have been successful in enrolling near record numbers of applicants since Jan. 1, 2014. Our interim, federally approved approach, pending the launch of a new computer system that is necessary to fully implement the changes mandated by ACA, relies heavily on the federally facilitated marketplace (FFM). This approach has worked well for the vast majority of applicants. “As it became apparent that some smaller groups of applicants encountered barriers obtaining coverage through the FFM, Tennessee has worked … and continues to work … tirelessly to develop workarounds to compensate for these flaws in the federal process, including developing a new workaround that has already helped all of the children named in the suit, a workaround that we communicated to plaintiffs’ counsel the day before they filed. “We have been engaged with opposing counsel for many months apprising them of the steps we were taking to continually improve the process for our citizens, and we are disappointed that the result of that open dialogue is yet another lawsuit brought by the Tennessee Justice Center.”
Eligible but not Enrolled Asked about how many Tennesseans might qualify for coverage who aren’t currently on the TennCare rolls, Tanksley said the numbers vary depending on the source. Prior to Jan. 1, the state developed its own estimates along with other groups including the Kaiser Family Foundation and the Robert Wood Johnson Foundation. “These pre-January 1 estimates for the Eligible but Not Enrolled population ranged from 60,600 to 101,000. We are not aware of any current estimates that are available on how many individuals have not yet applied,” she said. 4
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TennCare Fast Facts In August 2014, there were 1,279,189 enrolled in TennCare. Of that total, 495,252 were adults and 783,937 were children. An additional 64,681 children have coverage through enrollment in CoverKids. Another 123,098 Tennesseans (almost entirely adults) are enrolled in Medicare Savings Programs where the Bureau of TennCare assists individuals not otherwise eligible for Medicaid in paying Medicare premiums and cost sharing. Eligibility Criteria: In order to be eligible for TennCare, an applicant must first meet criteria to determine if they are “categorically” eligible. The TennCare program primarily covers: • pregnant women, • children, • parents and caretaker relatives of dependent children, • the disabled, • individuals needing long-term services, • and supports women needing treatment for breast or cervical cancer. Once it is determined an individual meets the categorical requirements, that person is then reviewed against income standards that differ for each eligibility category. In some categories, a review against an asset standard also applies.
The Application Process “Currently, most individuals seeking to apply for TennCare are directed to apply through the federally facilitated marketplace (FFM) either online via healthcare. gov, by phone or by mail,” explained Tanksley. “Applicants can receive in-person assistance at any county DHS office. Each DHS office has at least one trained certified application counselor … with a total of 350 statewide … to assist in the application process either using a computer kiosk available at each DHS office or, if preferred by the applicant, using a telephone made available at each DHS office.” Additionally, she noted, individuals with disabilities who need assistance and are unable to go to a DHS office can obtain in-home application assistance through a local Area Agency on Aging & Disability (AAAD) office. Tanksley added that while most applications for TennCare are currently made through the FFM, that isn’t true for every application. “The state does process some applications directly – including presumptive eligibility for pregnant women and coverage for women with breast or cervical cancer, which can be accessed through local health departments in every county.” She added the state also oversees enrollment processing of babies born to women enrolled in TennCare at the time they give birth and applications from individuals applying for long-term services and supports or Medicare Savings Programs. Applications falling in these categories can be filed directly with TennCare’s Call Center, she explained. On Aug. 18, the state implemented a newborn presumptive eligibility program. The new program allows participating facilities to enroll newborns in TennCare whose mothers are not enrolled in the program at the time of delivery but have self-reported incomes at or below the TennCare income limit. More information is available at tenncaretopics.com/ pregnant-women-eligibility.
The Long-Awaited Computer System “When the new computer system, referred to as TEDS, is up-and-running, applicants will have a choice between applying for TennCare through the FFM, as most do today, or applying through TEDS. Either doorway should be an equally effective pathway to TennCare eligibility,” Tanksley said. She added TennCare contracted with Northrop Grumman to develop TEDS, but implementation is behind schedule. “We are in the process of bringing in an internationally recognized consulting firm to evaluate our vendor’s progress to date and provide us with an objective third party estimate of the project timeline.”
Status on the Tennessee Plan “Conversations between the state and CMS are on-going,” Tanksley said of the Tennessee Plan that Gov. Bill Haslam pre-
sented to CMS officials as a way the state would consider expanding coverage. “We are focused on developing a plan for Medicaid expansion in Tennessee that will align consumer incentives in a manner that promotes consumer engagement in healthy behaviors and healthcare utilization decisions and that will align provider incentives in a manner that moves us from a system that pays for volume to a system that pays for value,” Tanksley explained. “We are working to refine our concept based on past discussions with CMS and given recent developments in other states.” However, she noted, any decision to expand Medicaid must be approved by state legislators. “The challenge is attempting to develop a proposal that would be acceptable to both CMS and the Tennessee General Assembly.” Looking Ahead While working through the immediate demands, Tanksley said the Bureau of TennCare is also focused on the future in terms of care delivery and quality. TennCare, in conjunction with the Department of Intellectual & Developmental Disabilities, has released a concept paper regarding the future of the state’s Home and Community Based Services (HCBS) for individuals with intellectual and developmental disabilities. The concept paper, along with summaries of comments and feedback from key stakeholders, are available online at tn.gov/tenncare/long_hcbsindividuals.shtml. Additionally, Tanksley said TennCare is looking at creating a new system aligning payment with quality for nursing facilities and certain HCBS providers. Information about the Quality Improvement in Long Term Services and Supports (QuILTSS) initiative can be accessed at tn.gov/ tenncare/long_quiltss.shtml.
Tennessee Facing, continued from page 2 their status. “We’ve gotten about 160 calls in the last six weeks about this issue,” Johnson said last month. “We’d never gotten a call before Jan. 1 from someone who was waiting 45 days.” While there were 11 plaintiffs in the original filing, the attorneys have asked the court to certify the suit as a class action. They are also seeking emergency help for those stuck in limbo. Johnson said they are asking for a court injunction requiring a decision be made within 72 hours after it has been brought to the attention of TennCare officials that an individual has waited more than 45 days for an eligibility determination. “On August 14, the state responded and filed a motion to dismiss the whole case,” Johnson continued. “They said we should have sued the federal government.” She added the state’s take on the situation seemed to be that the enrollment delays
were tied to failings with the federal marketplace and healthcare.gov site coupled with the ongoing problems with the state’s new computer system. However, Johnson noted every other state has managed to get its computer system working except Tennessee. Other states also offer in-person assistance to help individuals navigate a complex system. Johnson reiterated the federal online marketplace “was never meant to be the only door to obtain state coverage.” A hearing on the requests by both the plaintiffs and defendants was set for Aug. 29. In the meantime, costs and frustrations continue to mount. “Charity care clinics often require, rightfully so, some kind of proof that you’ve been denied coverage, but these folks can’t get that because they can’t get any answer,” said Johnson. “Tell them yes. Tell them no. But tell them something.” nashvillemedicalnews
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The Devil’s in the Details Local Exec Addresses Medicare Radiology Mandates on National Stage By CINDY SANDERS
Sheila Sferrella, CRA, MAS, a senior vice president with Franklin-based Regents Health Resources, tackled proposed Medicare mandates impacting diagnostic imaging for delegates at last month’s American Healthcare Radiology Administrators (AHRA) annual meeting in Washington, D.C. Part of a panel discussion on the Pro-
tecting Access to Medicare Act of 2014 (H.R. 4302), which was signed into law in April, Sferrella addressed the pros of implementing clinical decision support along with looming concerns over the feasibility of meeting the law’s tight timetable. “By 2017, Medicare has mandated that anyone performing radiology tests must have appropriateness criteria software,” she explained. “The trouble is, no one has this software, yet.”
The law, she said, targets advanced imaging including CT and MR and requires the testing meet certain criteria before being ordered. While most all payers currently require pre-authorization, the new guidelines will make that determination electronically. “There will be software that any physician or hospital that has imaging equipment will have to buy,” she noted. “It’s supposed to save money by cutting
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out having to call a payer,” Sferrella said of saving staff time. The bigger savings, however, comes from addressing overutilization. “That’s the issue radiology has had for years. Studies have shown that physicians who have their own equipment order more (imaging) studies than those who don’t,” she Sheila said. “We want people to Sferrella get tests they need … but not inappropriate tests.” For example, Sferrella noted, a patient presenting with back pain should have an x-ray as the first imaging option. Taking a stepwise approach, the software should deny a physician’s request to order an MRI for that patient if no other tests had been previously run. “We’re a society that wants to test,” she said. “Instead of doing an MR right away, which is what the patient wants, the literature shows if you wait 8-10 weeks, the vast majority of people feel better with physical therapy.” The American College of Radiology is creating the appropriateness criteria that will be turned into algorithms by software designers. Sferrella said a couple of pilot studies by CMS showed a 20-30 percent decline in utilization of imaging studies with clinical decision support in place. The downside? Sferrella said the concern is timing and the many unknowns. “We’re talking about a very short timeframe,” she said. “It seems like a long time, but from all my years in hospitals, you can’t implement a new system in less than 18 months from when you sign a contract.” There are no contracts to sign at this point because the software still doesn’t exist. Another concern she said is that legal protections didn’t accompany the mandate. “We don’t have any tort reform around appropriateness criteria,” she pointed out. What happens if a more cost effective imaging study doesn’t pick up a problem? What if a doctor tells a technician to override the criteria and perform a more advanced test? Those are the types of questions that need to be answered, Sferrella said. “We have no idea what it’s going to cost so that’s part of the challenge,” she continued, adding the financial hit is particularly concerning for smaller, rural facilities that are already struggling. A proponent of appropriate utilization, Sferrella said it’s also hard to ignore the anticipated impact in terms of lost jobs for many of those same small communities. “The average 250-bed hospital does 75,000-100,000 imaging studies annually so a 20-30 percent reduction equals another round of layoffs. That’s what it looks like to me.” The biggest issue, however, remains the timing. “You’ve got people who really don’t know a lot about healthcare creating (CONTINUED ON PAGE 12)
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PhysicianSpotlight
Dr. Christine Lovly Gains Worldwide Renown in Cancer Research By LARRY MCCLAIN
Damon Runyon was a colorful, chain-smoking writer whose short stories in the 1930s became the basis for the Broadway musical Guys and Dolls. The Runyon legacy lives on beyond show business, especially for Christine Lovly, MD, PhD, a Vanderbilt assistant professor of Medicine and Cancer Biology. After the author died from throat cancer in 1946, his friend and radio personality Walter Winchell established the Damon Runyon Cancer Research Foundation. Last year the foundation bestowed its Clinical Investigator Award to Lovly, providing $450,000 over three years for her research. Since receiving the Runyon award, Lovly has garnered other prestigious grants. She recently was the recipient of the LUNGevity Foundation’s Career Development Award for Translational Research, which provides $300,000 over three years. Lovly’s research focuses on ALK+ lung cancer, where the ALK gene gets in-
appropriately activated in tumors. There’s already one FDA-approved drug (and more on the way) that inhibits the activity of ALK, but virtually all patients eventually develop resistance to the therapy. The goal of Lovly’s research is to develop novel therapeutic approaches that delay or overcome acquired resistance to ALK inhibitor drugs. “At a certain point, everyone de-
velops this acquired resistance,” said Lovly. “It’s not a matter of if … but when … this occurs.” Her ongoing studies examine how ALK transmits signals to promote cancer growth, and how those signals get altered in the context of acquired resistance. This research has already led to the development of a novel ALK inhibitor that’s now in Phase I studies. Lovly grew up about 25 miles from Runyon’s beloved Broadway in Williston Park, New York on Long Island. She decided to pursue an MD/PhD dual degree while still in high school. “I had a wonderful high school chemistry teacher who encouraged me to take a summer job at a cancer hospital in New York,” she recalled. “From that point on, I’ve stayed totally focused on medicine and research.” Lovly earned her undergraduate degree in chemistry from Johns Hopkins University in Baltimore, then entered the MD/PhD program at Washington University in St. Louis. She came to Vanderbilt in 2006, spending two years in internal
medicine residency and four years on a hematology/oncology fellowship. She was the chief fellow during the 20112012 academic year before joining the faculty in 2012. Her laboratory is located in the Vanderbilt-Ingram Cancer Center (VICC), which also provides support for her research. Lovly has played an integral role in VICC’s My Cancer Genome online resource since its inception. The website provides clinically relevant information on tumor gene mutations and their implications for targeted care in cancer. When her mentor and former division chief William Pao, MD, PhD recently left the staff to lead oncology research at Roche, Lovly became the site’s co-editor with Mia Levy, MD, PhD. “My Cancer Genome is a freely available web-based resource that focuses on tumor mutations and the implications these mutations have for the treatment of cancer patients,” explained Lovly. “The content is predominantly geared toward physicians to be used to educate and in(CONTINUED ON PAGE 9)
“We are deeply saddened by the unexpected death of Dr. Eric Raefsky. It is a tremendous loss for patients, Tennessee Oncology and Nashville’s entire physician community. We have lost a fantastic colleague and a true friend.” - Jeff Patton, MD, CEO Tennessee Oncology
CARING FOR CANCER PATIENTS IS A PRIVILEGE
1.877.TENNONC • www.tnoncology.com
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Cancer Drug Studied at SCRI Shows Big Promise, continued from page 1 The Idelalisib Difference Traditional chemo agents work through cytotoxic chemotherapy, attacking the entire cell. Idelalisib is a targeted molecule, attacking one small pathway in the cancer cell and preventing off-target toxicity and side effects, including metabolism and glucose problems common with much broader agents. Another caveat of traditional chemo is the need for healthy bone marrow function. With idelalisib, patients can have bone marrow deficiencies and still receive treatment. Flinn said the primary concern during initial trials was the risk of resistance caused by targeting those narrow, redundant pathways in cancer cells. Six years later, idelalisib’s high remission rates are defusing those fears. “I’m excited about getting away from traditional chemo altogether and using a more targeted approach that can help patients avoid so many terrible side effects that often accompany chemotherapy,” Flinn said. Side Effects & Effectiveness Idelalisib is a daily, oral medication that is taken continuously, yet boasts surprisingly mild side effects compared to the nausea, vomiting and hair loss associated with traditional chemo. Flinn said some patients reported a rash or diarrhea after a year, while others noticed a slight change in liver enzymes. The drug label warning includes fatal and serious toxicities including liver toxic-
Research breakthroughs have given Dr. Ian Flinn (R) many more choices to fight hematologic malignancies.
ity, diarrhea and colon inflammation, lung inflammation and intestinal perforation that can occur in idelalisib-treated patients. Common lab abnormalities include decreased levels of white blood cells, high levels of triglycerides in the blood, high blood sugar and elevated levels of liver enzymes. Studies show tremendous improvement among patients who’ve been on the drug four years with decreased risk of progression or death from treatment, said Flinn. According to the FDA, idelalisib’s safety and effectiveness to treat relapsed CLL were established in a clinical trial of 220 participants who were randomly assigned to receive idelalisib and the IV chemo drug rituximab, or placebo and rituximab. The trial was stopped for effi-
cacy following the first pre-specified interim analysis point, which showed participants treated with idelalisib and rituximab had the possibility of living at least 10.7 months without their disease progressing compared to about 5.5 months for participants treated with placebo and rituximab. Results from a second interim analysis continued to show a statistically significant improvement for the combination of idelalisib and rituximab. “Although people on the control arm were allowed to cross over, we still saw improved survival,” Flinn said. “Idelalisib has the potential to change how patients with certain blood cancers receive treatment, and their outcomes can be greatly improved. It’s been an honor to watch our clinical trial participants thrive on the drug. This is why we do what we do … to improve the lives of those with cancer.”
In a Class of Its Own While idelalisib is known as a B Cell Receptor Pathway Drug, Flinn said the medication more specifically is a P13K Delta Inhibitor since it blocks pathways by interfering with the cell’s street map of survival signals. And while pan-P13K Inhibitors are already used in the treatment of solid tumors, idelalisib represents the first successful delta inhibitor for leukemia and lymphoma patients. “This is a tremendous paradigm shift for people who have relapsed lymphoma,” Flinn said. “In the future, our goal is to give idelalisib on the frontline so patients don’t
have to suffer side effects of traditional chemotherapy.” For now, Flinn said the drug is most effective in patients who have received prior treatment that was not effective. However, studies are underway to test the drug in patients with no prior therapy, although using idelalisib up front poses another host of questions: “How long are rates of remission? How well does it work in comparison to other treatments? Do you bring your best drug up front, and do you use it alone or in combination with something else?” Flinn asked. “We’re just starting trials to research this. When someone comes in, I tell them we’ll have this in a few years, but right now we’re only recommending it for relapse patients and not as frontline therapy.” While idelalisib is considered a win in the fight against blood cancers, Flinn and fellow researchers are already working on second and third generation molecules with hopes to create formulas with a broader spectrum of activity. Flinn is particularly hopeful about a drug that targets delta and gamma isoforms and promises less liver toxicity. “We’re working with other molecules in the same class to advance therapies to the next level,” Flinn said. “This medication and others coming along mean major differences for patients and are very different from how we treated lymphoma in the past. It’s really a major step as we develop more targeted treatment options for patients.”
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Vanderbilt Researchers Discover Protein Signature Behind Colon & Rectal Cancer By MELANIE KILGORE-HILL
A scientific breakthrough at Vanderbilt is changing the future of colon cancer treatment worldwide. Daniel Liebler, PhD, and his team at the Jim Ayers Institute for Precancer Detection and Diagnosis at the Vanderbilt-Ingram Cancer Center, have identified protein “signatures” of genetic mutations that drive colorectal cancer, currently the nation’s second leading cause of cancer deaths. Published in July’s issue of the journal Nature, the discovery is being hailed as “the first integrated ‘proteogenomic’ characterization of human cancer.” What is Proteogenomics? Simply put, proteomics is the study of proteins, and proteogenomics is the combination of proteomic and genomic study. In cancer, genetic abnormalities sometimes result in changes to proteins. By analyzing various genomes of cancers, researchers are generating a wealth of information about abnormalities. In this case, researchers at Vanderbilt and five other institutions used advanced mass spectrometry to gather proteomic data on 95 human colorectal tumor samples characterized previously by The Cancer Genome Atlas. Bing Zhang, PhD, an associate professor of Biomedical Informatics at Vanderbilt, led the analysis, which integrated the proteomic data with a vast amount of pre-existing genomic data. “The challenge is trying to understand which abnormalities in genes actually drive the characteristics or behaviors of cancer,” Liebler explained. “That’s very difficult to
Dr. Daniel Liebler
infer since living systems are complicated, but recent improvements in proteogenomic technology make it possible to understand abnormalities in genes, and which ones are likely to have the biggest driving roles. Strategic Partnerships The project first got legs in 2006, shortly after development of the Jim Ayers Institute. The Ayers family’s $10 million commitment allowed VICC to focus on development of new diagnostics for colon and rectal cancers and provided a platform to hire researchers, purchase instrumentation and compete for additional federal funding. Around that time, the National Cancer Institute also was launching an initia-
Dr. Christine Lovly, continued from page 7 form the patient at the point of care and to help facilitate enrollment in clinical trials based on the mutational profile of the patient’s tumor.” Lovly’s daily routine is enough to exhaust even the tireless Nathan Detroit from Guys and Dolls. “I split my time between the lab, clinic and office,” she said. “I meet frequently with students and postdoctoral fellows, reviewing their experiments and progress. And a good portion of my day is spent in teleconferences with collaborators at other institutions around the world. Then there’s the time spent writing and reviewing manuscripts, both my own and those sent by colleagues.” Despite this grueling schedule, Lovly finds time to enjoy the outdoors with her latest “project” – a two-year-old deaf boxer. “I got my boxer, Teagan, from Middle Tennessee Boxer Rescue,” she said. “They have been wonderful in helping me teach Teagan sign language so that we can communicate with each other. He knows signs for sit, stay, come, and more. I take him to the parks in Nashville, and the outdoor beauty is one of the things I really nashvillemedicalnews
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love about this area. I enjoy all the green space and open vistas. You don’t get much of that in New York.” In particular, Lovly enjoys the Radnor Lake area and Percy Warner Park. “Growing up in New York, the only ‘wildlife’ I ever saw were squirrels and pigeons,” she said. “I remember the first time I saw a turkey outside my apartment in Tennessee. I heard a weird noise about 5 a.m., and I was so surprised to see the turkey that I called my parents in New York to tell them!” Lovly also enjoys traveling. “I am very fortunate that I get to travel to attend conferences and give lectures,” she said. “On a personal note, my best recent vacation was a trip to Costa Rica – an amazing place with very nice people. I enjoyed zip-lining and swimming in the volcanic hot springs there.” For Lovly, cancer research isn’t just theoretical. Her clinical work puts her in close touch with cancer patients and what they’re experiencing. “My research is very translational,” she said. “I get to study patient tumor samples instead of just modeling disease. It’s a great opportunity because the patients are teaching us.”
tive to use proteogenomic technology to advance cancer diagnostics and soon named VICC one of five large grant recipients in their Clinical Proteomic Tumor Analysis Consortium. Led by Vanderbilt University, the five CPTAC teams represent a network of seven Proteome Characterization Centers located at Washington University and the University of North Carolina; the Pacific Northwest National Laboratory; Johns Hopkins University; The Broad Institute and Fred Hutchinson Cancer Research Center. The first five years of the initiative focused on removing technical barriers and enabling accurate and reproducible identification and quantification of proteins. Teams were then tasked with identifying cancer biomarkers in proteins using the newly pioneered technology. While select cancer-related biomarkers like prostate-specific antigen (PSA) are well known, the measurement of individual biomarkers has clinical limitations with respect to both sensitivity and specificity. According to CPTAC researchers, existing studies of the recognized 1,000-plus cancer protein biomarker candidates derive mostly from diverse research groups working independently on available clinical specimens. Consequently, the findings are typically based on an insufficiently low number of samples to provide the adequate statistical power required for rigorous evaluation of protein changes. Relatively few of these candidates have been validated, and even fewer have made it into diagnostic products. Producing Results CPTAC’s discovery marks a tremendous milestone for proteogenomics research, which Liebler says experienced a 10-15 year technology lag behind the field of cancer genomics. “Our network had to spend so much time working out technological challenges, and when those issues were largely resolved, the question was, ‘Now that you can conduct
these analyses what good are proteogenomics?’” Liebler said. “It was a ‘put up or shut up’ issue, and our paper ‘put up.’” It certainly did. Liebler’s team substantiated proteogenomic research by identifying high impact genomic abnormalities, which help identify the strongest drivers in cancer. They also identified five subtypes of colon cancer including one believed to possess protein molecular features associated with poor outcomes and rapid spread to other tissues. “We know that colon cancers have a variety of abnormalities,” Liebler said. “Some are thought to be pretty well understood, and others not so much. In colon cancer, as well as other cancers, genomics suggests there are multiple subtypes.” That’s very important, since colon cancer patients are typically diagnosed mid-stage while cancer is still confined to the colon. Following surgery, patients face a 20 percent risk of relapse with no reliable test to identify those most in need of aggressive chemo afterward. “The general problem in cancer is figuring out which subtype of tumor the patient has, as that will guide the decision of who to treat with chemo and which drugs will be most effective,” Liebler said. Liebler noted identifying a proteogenomic signature is a concept that needs to be further honed through independent studies using other tumors from other patients. Additional studies are already underway at Vanderbilt and other CPTAC facilities. Though still early in the game, researchers are optimistic that identification of proteogenomic subtypes could provide new ideas for targets of drugs directed at different subtypes of tumors, including those in the breast and lungs. “We figured out which proteins are indicators of which subtypes,” Liebler said. “Our next step is to measure proteins in tumors and figure out which subtypes are characteristic of which cancers. Our goal is to translate this to a diagnostic test that can be run on every colon tumor after surgery, which would help physicians make the right decision about what to do after surgery.”
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Full Spectrum Endoscopy a Game Changer By MELANIE KILGORE-HILL
Advances in screening technology are making colonoscopy more accurate and efficient than ever before. In July, Franklin Surgery Center became one of the first sites in Tennessee to adopt the FUSE® Full Spectrum Endoscopy®. Franklin Gastroenterology’s Wilmot Burch, Jr., MD, said he was introduced to the scope at a national conference and was intrigued by the idea of 330-degree visibility. “When it comes to colon cancer prevention, every innovation with colonoscopy has been to improve visualization and detection,” Burch said. Traditional forward-viewing (TVF) endoscopes generally capture a 170-degree view of the colon. With almost double the field of view, EndoChoice, manufacturer of the FUSE Full Spectrum Endoscopy, claims their system de-
330º view over the three screens of a colon animation with a polyp on the far right.
tected 69 percent more adenomas than TVF during a multi-center tandem trial. Three weeks after implementing FUSE in his Franklin practice, Burch, a board certified gastroenterologist, said the procedure feels the same as traditional scopes but with a few adjustments — greater views mean three screens to monitor instead of one and a clearer view of angles means easier navigation.
“In the past few weeks I can think of at least a half dozen times I saw polyps I hadn’t seen before because they were in an extreme visual field on one side or the other,” Burch said. “We’re not perfect and technology isn’t either, but I know I’m seeing polyps easier than I did before.” Another diagnostic innovation scheduled to hit Franklin Gastroenterology this month is
PillCam® COLON. Earlier this year, the Food and Drug Administration gave limited approval for use of the non-invasive, radiation-free imaging solution for the detection of colon polyps in patients after an incomplete optical (failed) colonoscopy. Previously, the FDA has approved capsule imaging for use in the small intestine and esophagus. Burch, who is undergoing training on the new PillCam this month, said he suspects broader approval will be forthcoming. In addition to its approved use, it also could be offered as a screening tool for those who are resistant to traditional colonoscopy, but the diagnostic tool wouldn’t be covered by insurance given current FDA clearance. Still, Burch said, it’s a good alternative for someone who might otherwise forego screening altogether. Much broader use of the technology has already been approved in Europe, Japan, Canada and Australia.
Sarah Cannon Blood Cancer Network Among Largest Transplant Providers in Nation By: MELANIE KILGORE-HILL
The legendary Sarah Cannon … aka Minnie Pearl … will forever be a Nashville icon and national treasure. Today, HCA’s cancer service line named in her honor also is touching lives across the country. Headquartered in Nashville, the Sarah Cannon Blood Cancer Network now ranks as one of the largest providers of blood and marrow transplantation (BMT) across the United States and United Kingdom, conducting more than 800 transplants annually. With five network members and three additional HCA BMT centers, more than 9,500 patients have been treated since the inception of
the first program. Rocky Billups, vice president of Operations for Southwest, Central Group Hematology/BMT, said the program’s
quality and consistency of care make it unique. “In 2011, we brought programs together with standardized policies and procedures, clinical pathways and nursing and physician education to provide quality programs,” Billups explained. “Our goal is to have the same standard of care whether a patients is transplanted in Nashville or Denver.” Additionally, network-wide standardization means patients gain access to Sarah Cannon’s clinical trials regardless of which site they visit. Quality improvement measures include an oncology alert program that equips patients with an identification card to present at any partner facility’s ER. The patient immediately receives a
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private room, is Blood medical asCancer sessment and Awareness antibiotics. Month The measure has driven the admit-to-antibiotic time to less than 45 minutes – an impressive feat compared to the 187-minute national average. The program is already underway at TriStar Centennial Medical Center and is expected to be implemented across all HCA facilities in the coming months. The network also provides an international platform for cancer research and physician education, said Tonya Cox, assistant vice president of the Blood Cancer Network. “National data shows that many physicians believe transplantation isn’t appropriate for older patients and part of the message we want to get out is that data is showing it can be safe for older patients thanks to newer therapies that weren’t available a decade ago,” Cox said. “That’s huge in terms of improving survival of blood cancer patients.” The Sarah Cannon Research Institute also includes a Blood Cancer Research Consortium – a group of thought leaders in blood cancer investigation who, in partnership with SCRI, have built a network integrating research into their treatment centers. Every site includes principal investigators, sub-investigators and dedicated research staff to assist with protocol adherence, data collection, and regulatory and safety compliance. In addition to investigator-initiated clinical trials, the sites also partner with pharmaceutical and biotechnology companies to develop new compounds for the treatment of blood cancer.
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Lung cancer causes more deaths in the United States than any other type of cancer The American Cancer Society estimates more than 224,000 new cases and 159,000 deaths will occur in the nation this year. Tennessee is in an epicenter of the epidemic. Approximately 6,000 new cases and more than 4,600 deaths will occur in Tennessee this year alone. The state has the highest incidence of lung cancer in the country behind Kentucky, Mississippi, Arkansas and West Virginia. The high case and death numbers can be attributed to cigarette smoking, the leading risk factor for lung cancer. Kentucky has the highest smoking rate in the nation – 30.2 percent of Kentuckians smoke. However, Tennessee ranks just outside the top five with the ninth highest smoking rate in the nation – 26.2 percent of Tennesseans smoke. Tennessee Oncology provides care to a large number of patients with lung cancer who live in the state and around the region. Tennessee Oncology offers the latest in state-of-the-art radiation and therapies for advanced disease in lung cancer care, as well as research advances (in partnership with the Sarah Cannon Research Institute) to patients in its communities. There are many additional, exciting areas of lung cancer care and research that are changing how patients with lung cancer are diagnosed and treated, ranging from advanced imaging to therapies designed to boost the immune system. An exciting and promising frontier in lung cancer care is personalized treatment. Oncologists now have the ability to look deeper into lung cancer, better understanding the unique signals that may cause cancers to grow and spread. This new intelligence allows oncologists to better select possible therapy to potentially target the signs.
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THE OBVIOUS CHOICE FOR CANCER CARE IN TENNESSEE
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Kraft Healthcare Leads Cuban Trade Mission, continued from page 1 an affordable manner. Mertie approached Caroline Young, president of the Nashville Health Care Council, to tap into her expertise in creating meaningful foreign trade missions. The result is a Kraft Healthcare-led delegation to Cuba next month to study the successes and challenges of a community health system that has an emphasis on prevention and to learn more about the country’s robust physician education programs. With room for 24 attendees, the delegation quickly filled up. In addition to Young and former U.S. Senate Majority Leader Bill Frist, MD, who has also signed on to attend the trip, Mertie will be joined by healthcare executives representing a cross-section of the industry ranging from providers, facility operators and developers to HIT and revenue cycle management experts. Although travel from the United States is still limited, there has been some lessening of restrictions over the last few years for Americans. Mertie explained Insight Cuba, which is facilitating the tour planning and meetings in Havana, is one of only a handful of companies that have a contract with the U.S. Department of the Treasury to put together cultural exchanges, such as the Oct. 9-12 Nashville delegation. During the trip, the Nashville executives will tour the Latin American School of Medicine in Havana, one of the coun-
try’s largest medical schools. Mertie noted Cuba produces a large number of physicians to work at home and abroad. “They export a significant number to third world countries for humanitarian reasons,” he noted. “You think of Cuba as being ‘taboo’ and in their own little world … but that’s just Scott Mertie, to America. They aren’t CHFP, CMPE closed off to other countries.” The Middle Tennessee group also will have an opportunity to engage in informal conversations with students and professors, he added. Much of the trip’s focus will be on how the country restructured their health system over the last 55 years. “After the revolution in ’59, they put in a national healthcare system,” noted Mertie. “Then in the early ‘80s, they really put an emphasis on preventive care … pushing screenings, health and wellness ... things we’re just now starting to do here 30 years later.” Mertie added Cuba’s community medicine program is tiered with the catchment area getting larger as acuity rises. “They have a family doctor unit, which is what we’d think of as a primary care physician,” he noted. That physician would be located within a neighborhood or cover a small geographic area. “In general, physicians there see about 1,000
patients a year. In America, it’s more like 2,000-2,500 per year.” If care needs exceed the capabilities of the neighborhood physician, then a patient would go to a polyclinic, which covers multiple family doctor units. For inpatient needs, regional hospitals care for patients in a polyclinic cluster. “As with most of the world outside the United States, they do not have the long-term care nursing home environment like we do in this country. It’s the family’s responsibility to care for grandma or grandpa,” Mertie said. However, he continued, there are grandparent homes that serve as a day option for seniors to allow other family members to work. The local group plans to visit one of the facilities designed for seniors. Mertie hopes the delegation will also have a chance to visit a community mental health clinic, which he said operates much in the same manner as in the United States. Additionally, the trip includes meetings with physicians and executives with a polyclinic and pharmacy, plus a tour of a large hospital and presentation by representatives from the Ministry of Health. The group will also enjoy a general overview of the economic picture of Cuba, including how healthcare has been integrated in the past and present, and attendees also will have the opportunity to experience some of the country’s cultural landmarks.
“I think the biggest thing we want to bring back is to learn what they are doing from the perspective of what causes them to have a longer lifespan than most other countries, and how they are doing it in an affordable manner,” Mertie concluded.
The Devil’s in the Details, cont. from page 6 regulations, and they don’t understand the complexities of implementing them,” she said. Backing up from the January 2017 implementation date, Sferrella said the standards really need to be in the hands of vendors in the next six months if there is to be time to work through all the steps and conduct end-to-end testing. As is often the case … the devil is in the details. In addition to sharing insights on regulatory issues, she also led two Certified Radiology Administrator workshops during the meeting. Sferrella helped create the CRA certification program in 2002 when she served as president of the AHRA. She joined Regents Health Resources in June. A former Saint Thomas Health executive, Sferrella was most recently with Collaborative Consulting Solutions, a firm she founded to work with group practices, academic medical centers and other healthcare facilities to identify cost savings and conduct operational analysis.
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Quillen College of Medicine, Department of Internal Medicine at East Tennessee State University is seeking BC/BE (at time of hire) Internists to join their groups in Johnson City and Kingsport, Tennessee at the Assistant/Associate Professor level. Responsibilities include teaching residents and medical students ambulatory care in our University practices, with in-patient attending at our community partner teaching hospitals, and the opportunity for clinical research. Scholarship is an expectation of all faculty with protected time for scholarly activities. Competitive pay, comprehensive benefits package, CME allowance and relocation support provided. Women and minorities are encouraged to apply. AA/EOE
Quillen College of Medicine is a community-based medical school whose mission emphasizes primary care. Located in the beautiful mountains of northeast Tennessee, Quillen College of Medicine serves the healthcare needs of over 1 million people. The Tri-cities area boasts low crime rate, low cost of living, award-winning public school systems and no state income tax.
Apply at: https://jobs.etsu.edu Inquiries can be directed to: Stephen Geraci, M.D., Professor and Chairman of Internal Medicine via Karen A. Heaton, Quillen College of Medicine, Box 70622, Johnson City, TN 37614. Phone (423)439-6367; email: heatonka@etsu.edu. nashvillemedicalnews
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HealthcareEnterprise
Bernard Health: A Different Approach to HSAs By KELLy PRICE
Nine years ago, while a third year graduate student at Vanderbilt, Alex Tolbert had an ‘Aha!’ moment. The concept of Bernard Health came to him while sitting in a class on health law at Vanderbilt Law School. One of the concepts discussed by Professor James Blumstein was a health savings account. Tolbert realized HSAs could help redirect a lot of the misaligned incentives that were taking healthcare coverage in the wrong direction. When Tolbert arrived in Nashville to earn a graduate degree in a combined JD/ MBA program at Vanderbilt, he thought he would move to New York after finishing his education to work for a hedge fund. What got in the way of his carefully crafted life plan was that insight into the healthcare system and the conviction that he could help build a better mousetrap. Soon after, in June 2006, Bernard Health got its start. Nine months later, Alex was joined at the nascent company by his brother, Brian, who left Cleveland and came to Nashville to help grow the start-up business. The brothers soon realized two things: many employers do not get the advice they need to provide healthcare coverage to their employees, and individuals have nowhere to go for a health insurance education and advice. Tolbert said, “We formed Bernard with the mission to be the world’s most trusted advisor in helping people plan how to pay for both expected and unexpected healthcare expenses.” The Tolberts realized that what kept employers from succeeding was a plan structure that did not strike the right bal-
ance between how much savings to keep versus how much to share with employees. They also saw that using the right terminology and building a strong support system could have a huge impact on helping employees choose to be part of the HSA. Tolbert said, “We asked, ‘Do you ensure your HSA messaging gets to the spouse? Do you provide effective pricing tools?’” He continued, “The right plan structure that strikes the right balance between employer and employee saving requires excellent communication. The best HSA messaging is important to ensure your people understand how it all works.” The strategy worked. “We have been building a track record — first-year HSA participation rose to a rate of 82 percent. This is more than 10 times better than industry averages and means significant bot-
tom-line savings for our clients,” Tolbert continued. He added an important element of the company’s success is the support they offer clients including assigning a Bernard nurse to help employees price-shop their prescriptions and a claims and billing support team that knows how to help employees participate in HSA savings. Knowing how critical communication is, Bernard provides a customizable, web-based video to ensure consistent HSA messaging gets to spouses at home. “We found that while many employers do not get the advice they need, individuals and families have almost nowhere to go for health insurance advice. We felt that people would like to go into a ‘storefront’ and have face-to-face interaction with experts in designing their plan,” Tolbert said. The stores allow clients to sit down with a trained advisor to discuss their unique situations. There are now three Bernard locations in the Nashville area (Thompson Lane, Harding Pike and Franklin), as well as storefronts in Indianapolis, Austin and Ohio. “We look forward to putting down roots across the country with a network of healthcare retail stores where we could ‘rescue you from healthcare confusion,’”
he said. Tolbert laughed, “We want people to say, ‘We went to Bernard’ with the same inflection and pride as they do with a popular jeweler — that it is sign of trust and competency.” Tolbert said Bernard should have a presence where people could use the most help. “We realized it was a lot more comfortable to advise the patient than the company —that’s our core competency. This is where we’ve had the fastest growth — working to help with patient solutions, and we find that generally what’s best for patient is what is best for providers.”
Online Event Calendar To submit or view local events visit the Nashville Medical News website and click on the calendar icon on the right hand sidebar.
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Corrections In the August issue of Nashville Medical News, the “Growing Strong” article on orthopaedics incorrectly stated TriStar Summit Medical Center’s new Total Joint Center had opened a ’12-bed inpatient rehab center.’ In fact, it is an eight-bed unit. In the July issue article “A Matter of Choice,” we reported The Crichton Group was the first in Tennessee to go live with a private exchange for a client. In fact, Aon Hewitt, the largest U.S. human capital consultant with a presence in Tennessee, made their private exchange available to Tennessee employers several months earlier at the beginning of 2013. Nashville Medical News always strives to ensure accuracy. We regret these errors.
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GrandRounds Sept. 15-17 • Healthcare Deal Making Summit • Music City Center
The annual summit brings senior executives from provider and service organizations together with leading investors and financial service providers to explore business strategies and new models of care and to help identify the best investment opportunities in the still evolving post-Affordable Care Act world. Harry Jacobson, MD, is the keynote speaker. For more information, go online to informationforecastnet.com/ events/healthcare-deal.
Vanderbilt Enrolling Children with Autism in MedicationRelated Weight Gain Study
Vanderbilt University is one of four sites in North America to enroll children with autism in a study to examine weight gain commonly experienced while taking antipsychotic medication. Medications prescribed in up to 20 percent of children with autism, including Risperdal, Abilify, Seroquel and Zyprexa, often cause substantial weight gain and put children at greater risk for developing diabetes. “Right now, parents are placed in the difficult position of deciding between their children’s physical health or losing the beneficial effects of the medication on behavior,” said Kevin Sanders, MD, medical director of the Treatment and Research Institute for Autism Spectrum Disorders at Vanderbilt. This new study will examine if the investigational drug metformin is safe and helpful in reducing weight gain in these children. While metformin, most commonly used to treat diabetes, has been studied in adults and been shown to be an effective approach to weight gain, there is limited information on its effectiveness in children … and it has never been studied in children with autism, who often respond differently to medication. Study participants will receive treatment at no cost. For more information or to refer a patient to this study, contact Sarah Marler, MA, at (615) 936-3288 or sarah.marler@vanderbilt.edu.
Urology Associates, Center for Urological Treatment Merge
Urology Associates, the region’s largest urological practice, and the Center for Urological Treatment (CUT) have merged in a move that creates a greater collaborative care network designed to provide enhanced patient care. “Urology Associates believes CUT is the perfect partner, because both practices share a similar goal of improving our patients’ urological care experience,” said Charles W. Eckstein, MD, president of Urology Associates. He added Tara M. Allen, MD, Howard A. Aubert, MD, L. Dean Knoll, MD, and Mitchell L. Wiatrak, MD, have joined UA as part of the merger, which went into effect July 1. All are board certified in urology.
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UNHS Adds Dental Wing at Main Street
Last month, United Neighborhood Health Services announced it has expanded its realm of care by adding dental capabilities at its Main Street Health Center. The clinic underwent extensive renovations completed over the summer that included the addition of a new dental wing. The clinic can now serve patients ages two and up with a variety of services including exams, x-rays, fillings, extractions partials and dentures. In addition, UNHS has expanded its dental care for homeless patients at its Union Mission location. Delta Dental of Tennessee provided close to $90,000 in funding for the installation of additional dental chairs to triple the number of homeless patients UNHS can serve. The funding was made possible through the Delta Smile 180 initiative.
Let’s Give Them Something to Talk About!
Awards, Honors, Achievements HCA President & CFO R. Milton Johnson is one of 22 leading corporate executives to join the American Heart Association CEO Roundtable, a new initiative designed to create a workplace culture in which healthy choices are the default choices. With 49 businesses, R. Milton Middle Tennessee was Johnson well represented in the recent Inc. Magazine’s list of the 5,000 fastest-growing private companies in America. The area’s top two in the rankings were both healthcare companies – Entrada (#281) and InQuicker (#291). In addition, American Addiction Centers (#474) also made the top 500. Other area healthcare names that appeared on the list include HCTec Partners, Santa Rosa Consulting, Continental Health Alliance, Qualifacts, Medi-Copy Services, EnableComp, Cumberland Consulting Group, and Centerre Healthcare. Modern Healthcare recently released its 2014 list of 100 “Best Places to Work in Healthcare.” The list included several names familiar in this area: BlueCross BlueShield of Tennessee, Change Healthcare, Cumberland Consulting Group, Entrada and Santa Rosa Consulting. Last month, Paula Lovell, founder and CEO of Lovell Communications, Inc., and Rachel Seifert, executive vice president, secretary and general counsel for Community Health SysPaula Lovell tems, were named “24 of the leading women to know in healthcare” by Becker’s Hospital Review. Three Qsource employees have been ap- Rachel Seifert pointed by the Board of Directors of the Tennessee Center for Performance Excellence (TNCPE) to the 2014 TNCPE Board of Examiners.
Appointees are Alyssa Chase, population & community manager; Stacy Dorris, quality improvement specialist; and Alex Babakus, quality management coordinator. NorthCrest Medical Center has been nationally recognized for its participation in the Tennessee Surgical Quality Collaborative (TSQC), which has reduced surgical complications by 19.7 percent since 2009. This reduction represents at least 533 lives saved and $75.2 million in reduced costs in Tennessee.
Wang Debuts Cassini Corneal Imaging
On July 10, Ming Wang, MD, PhD, debuted the new Cassini topographer, which uses patented color point-to-point LED technology to provide measurements and a map of the cornea. Wang, who offers several 3D procedures, noted, “With these mod- Dr. Ming Wang ern 3D laser eye procedures, determining corneal shape accurately and precisely is of critical importance in order to properly correct astigmatism and produce optimal vision for our patients.”
Certifications & Accreditations
Tennessee Maternal Fetal Medicine was recently awarded AIUM Ultrasound Practice Accreditation, making it one of only four maternal fetal medicine locations in Tennessee to hold the designation in the area of fetal echocardiography by the American Institute of Ultrasound in Medicine. By achieving this accomplishment, TMFM can examine the structure of a fetus’s heart while still in the womb to detect potential abnormalities, providing patients with even greater detail than a routine obstetric ultrasound (for which TMFM has been accredited since 2008). TMFM has been accredited in Obstetric Ultrasound since 2008. Additionally, TMFM has 11 sonographers individually certified in the area of fetal echocardiography, and the practice’s sonographers also provide ultrasound services at Saint Thomas Midtown, the only AIUM accredited perinatal testing center in Nashville. Scott Mertie, president of Nashville-based Kraft Healthcare Consulting, LLC, recently earned the credential of Certified Medical Practice Executive (CMPE) from the American College of Medical Practice Executives, an entity of the Medical Group Management Association. Mertie has more than 20 years of reimbursement, operational and financial experience in the healthcare industry, and consults with healthcare clients throughout the country.
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GrandRounds Bowers Steps Into New President & COO Role at Corizon Effective last month, Scott A. Bowers began his new role as president and chief operating officer for Brentwood-based Corizon Health. Most recently, Bowers served as president and CEO of UnitedHealthcare Community Plan of Tennessee and Scott A. Bowers brings 18 years of healthcare management experience to his new post. He is responsible for building a robust business intelligence function to ensure transparency and accountability for results, as well as leading key management personnel throughout the company. Bowers, who has extensive health plan experience, earned his undergraduate degree from Princeton and his MBA from Washington University in St. Louis.
Rough Month for CHS Last month proved to be a tough one for Franklin-based Community Health Systems. In early August, the U.S. Department of Justice announced the company had agreed to pay more than $98 million to resolve allegations of overbilling Medicare and Medicaid by unnecessarily admitting patients to 119 of its hospitals across the country. In a statement, CHS officials denied any wrongdoing and said the settlement reflected the company’s desire to end the three-year investigation to avoid further expense and the distraction of litigation. Two weeks later, the company reported a massive breach of non-medical patient data that was believed to occur in April and June. In filing details of the cyber attack with the Securities and Exchange Commission, CHS’ forensic expert said approximately 4.5 million individuals were affected. While no patient medical or financial data was stolen, the breach did involve HIPAA-protected personal identification information including names, birthdays and Social Security numbers. The sophisticated attack was believed to have originated in China.
DMA Names Director of Finance and Business Development Christie Mathis, CPA has assumed the role of director of Finance and Business Development for Dickson Medical Associates, a large multi-specialty, physician-owned medical group with eight locations. Mathis has more than Christie Mathis 10 years of experience working in diverse finance positions. Her background includes positions at publicly traded HCA-Physician Services
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“Finding the partner that gave us large-bank thinking with local-bank attention was a real TURNING POINT for our business.”
and Philips Healthcare. She has expertise in financial planning and analysis, M&A, business development, process re-engineering and change management. A certified public accountant, she earned her undergraduate degree from Middle Tennessee State University and her MBA from Belmont University.
Brown Takes Exec Role with HORNE’s Delivery Institute
HORNE LLP recently announced the hiring of Alexandra Brown, MD, as the associate director of its Healthcare Delivery Institute. Brown joins Director Thomas Prewitt, MD, on the leadership team of the institute where she will focus on the developDr. Alexander ment and instruction of Brown the Advanced Training Program. For information about upcoming schedules for ATP, go online to http:// connect.horne-llp.com/hdiatp.
Radiology Alliance Adds Three James M. Massey, MD, PhD, specializes in diagnostic and pediatric radiology, has joined Radiology Alliance, P.C. He earned his Doctorate of Medicine and Philosophy from the University of Louisville School of Medicine in Louisville, Ky. and Dr. James M. Massey completed a transitional internship at Akron General Medical Center, a residency in radiology at Cleveland Clinic, and a pediatric radiology fellowship at Indiana University School of Medicine in Indianapolis. R. Steven Young, MD, who specializes in interventional and diagnostic radiology, has also joined the practice. Previously, Young was a partner with Advanced Radiology Associates of Southern Tennessee in Winchester. He received his medical deDr. R. Steven gree from Virginia ComYoung monwealth University School of Medicine in Richmond and performed a diagnostic radiology residency at Vanderbilt, where he was the chief resident from 2010 to 2011. Young performed an interventional radiology fellowship at the University of Virginia Health System in Charlottesville. Miles O. Foltermann, who specializes in women’s imaging, earned his medical degree from the University of Texas Health Science Center at Houston and completed a transitional internship at Methodist Hospital in Houston. He returned to Miles O. Foltermann the University for a residency in diagnostic and interventional radiology. Prior to joining Radiology Alliance, Foltermann completed a women’s imaging fellowship at Vanderbilt, where he also served as a clinical instructor. All three are board certified.
Hugh Durrence, M.D.
PHC Health
Get the whole story at regions.com/phchealth
Since opening PHC Health in 1986, Dr. Hugh Durrence had envisioned creating a multiservice medical company to provide all levels of care – from medical equipment and in-home nursing to outpatient rehab services – throughout the community. His vision is now a reality, but as his business grew so did his banking needs. Finding most banks slow and inflexible, he turned to his Regions Business Banker who helped the company navigate the process of acquiring a new location. Finding such a smart, prepared and passionate advisor was a turning point for Dr. Durrence, one that convinced him he’d found a banking partner to help his business move forward. To see how we can help your business move forward when it’s at a turning point, turn to Regions.
Loans | Treasury Management | Can-Do Attitude
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